Comparison of evaluation metrics of deep learning for imbalanced imaging data in osteoarthritis studies.

PURPOSE: To compare the evaluation metrics for deep learning methods that were developed using imbalanced imaging data in osteoarthritis studies. MATERIALS AND METHODS: This retrospective study utilized 2996 sagittal intermediate-weighted fat-suppressed knee MRIs with MRI Osteoarthritis Knee Score readings from 2467 participants in the Osteoarthritis Initiative study. We obtained probabilities of the presence of bone marrow lesions (BMLs) from MRIs in the testing dataset at the sub-region (15 sub-regions), compartment, and whole-knee levels based on the trained deep learning models. We compared different evaluation metrics (e.g., receiver operating characteristic (ROC) and precision-recall (PR) curves) in the testing dataset with various class ratios (presence of BMLs vs. absence of BMLs) at these three data levels to assess the model's performance. RESULTS: In a subregion with an extremely high imbalance ratio, the model achieved a ROC-AUC of 0.84, a PR-AUC of 0.10, a sensitivity of 0, and a specificity of 1. CONCLUSION: The commonly used ROC curve is not sufficiently informative, especially in the case of imbalanced data. We provide the following practical suggestions based on our data analysis: 1) ROC-AUC is recommended for balanced data, 2) PR-AUC should be used for moderately imbalanced data (i.e., when the proportion of the minor class is above 5% and less than 50%), and 3) for severely imbalanced data (i.e., when the proportion of the minor class is below 5%), it is not practical to apply a deep learning model, even with the application of techniques addressing imbalanced data issues.

Covered SEMS failed to cure airway fistula closed by an amplatzer device.

BACKGROUND: Airway fistula is a rare but threatening complication associated with high rates of morbidity and mortality. We report the experience of Amplatzer device application in airway fistulae that failed to be cured with a covered self-expandable metallic stent (SEMS). MATERIALS AND METHODS: Patients who failed occlusion with a covered self-expandable metallic stent and received Amplatzer device placement from Jan 2015 to Jan 2020 were retrospectively enrolled. A total of 14 patients aged 42 to 66 years (55.14 ± 7.87) were enrolled in this study. The primary diseases, types of fistula, types of stents, duration, size of fistula, and follow-up were recorded. RESULTS: All 14 patients with airway fistula failed to be occluded with a covered metallic stent and received Amplatzer device placement. Among the 14 patients, 6 had BPF, 3 had TEF and 5 had GBF. The average stent time was 141.93 ± 65.83 days. The sizes of the fistulae ranged from 3 to 6 mm. After Amplatzer device placement, the KPS score improved from 62.14 ± 4.26 to 75.71 ± 5.13 (P < 0.05). No procedure-related complications occurred. During the 1-month, 3-month and 6-month follow-ups, all the Amplatzer devices were partially surrounded with granulation. Only 1 patient with BPF failed with Amplatzer device occlusion due to the recurrence of lung cancer. CONCLUSION: In conclusion, the application of the Amplatzer device is a safe and effective option in the treatment of airway fistula that failed to be occluded with SEMSs.

Non-Surgical Carpal Arch Space Augmentation for Median Nerve Decompression.

The carpal tunnel is a tightly bounded space, making the median nerve prone to compression and eventually leading to carpal tunnel syndrome. Carpal tunnel release surgery transects the transverse carpal ligament to expand the tunnel arch space, decompress the median nerve, and relieve the associated symptoms. However, the surgical procedure unavoidably disrupts essential anatomical, biomechanical and physiological functions of the wrist, potentially causing reduced grip strength, pillar pain, carpal bone instability, scar tissue formation, and perineural fibrosis. It is desirable to decompress the median nerve without surgically transecting the transverse carpal ligament. This paper is to review several approaches we have developed for nonsurgical carpal arch space augmentation (CASA), namely, radio ulnar wrist compression, muscle-ligament interaction, palmar pulling, and collagenolysis of the transverse carpal ligament. Briefly summarized is the research work on the CASA topic about theoretical considerations, in vitro and in situ experiment, computational modeling, and human subject studies with asymptomatic and carpal tunnel syndrome hands.

Spatial Relationship of the Median Nerve and Transverse Carpal Ligament in Asymptomatic Hands.

The spacing between the median nerve and transverse carpal ligament (TCL) within the carpal tunnel can potentially affect the nerve morphology. This study aimed to quantify the spatial relationship between the median nerve and transverse carpal ligament in asymptomatic hands. Twelve subjects were recruited to image the carpal tunnel using robot-assisted ultrasound. The median nerve and TCL were segmented from each image and three-dimensionally reconstructed using kinematic information from the robot. The TCL-median nerve distance, nerve cross-sectional area, circularity, and position were measured along the entirety of the nerve length within the carpal tunnel. Results were averaged at every 5% of nerve length. At the nerve length percentages of 0% (distal), 25%, 50%, 75%, and 100% (proximal), the TCL-median nerve distance (±SD) was 0.7 ± 0.4, 0.7 ± 0.2, 0.5 ± 0.2, 0.5 ± 0.2, and 0.6 ± 0.3 mm, respectively. The corresponding nerve cross-sectional area was 9.4 ± 1.9, 10.6 ± 2.6, 11.2 ± 2.1, 11.2 ± 1.7, and 9.7 ± 1.9 mm2. A one-way analysis of variance showed no significant differences between the respective percentages of nerve length for TCL-median nerve distance (p = 0.219) and cross-sectional area (p = 0.869). Significant (p < 0.0001) but weak correlations were observed between the TCL-median nerve distance with cross-sectional area (r = -0.247) and circularity (r = -0.244). This study shows that the healthy median nerve morphology is consistent along the continuous nerve length within the carpal tunnel, supporting the use of 2D imaging in the evaluation of the healthy nerve.

Preliminary application of brachytherapy with double-strand 125I seeds and biliary drainage for malignant obstructive jaundice.

AIM: To evaluate the efficacy and safety of brachytherapy with double-strand 125I seeds and biliary drainage for malignant obstructive jaundice. METHODS AND MATERIALS: 42 patients with obstructive jaundice because of extrahepatic cholangiocarcinoma were enrolled. 22 patients (group A) received a biliary stent with common drainage tube implantation, and 20 patients (group B) received a biliary stent with double-strand 125I seeds radiotherapy drainage tube placement. The length, location and pathological stage of biliary stricture were recorded in the two groups. Total bilirubin (TBIL), direct bilirubin (DBIL), IgA, IgG, IgM, alanine aminotransferase and white blood cell (WBC) count were measured before and after percutaneous transhepatic cholangial drainage (PTCD). Tumor diameter was measured before and three months after PTCD, and the difference were calculated. Stent patency time, survival time, and complications were recorded. RESULTS: There was no significant difference in the length, location and pathological stage of biliary stenosis between the two groups. There was no significant difference in TBIL, DBIL, IgA, IgG, IgM, alanine aminotransferase and WBC count between the two groups before or after PTCD (P > 0.05). Three months after PTCD, tumors growth in group A and tumors shrinkage in group B. The difference in tumor size between the two groups before and after PTCD was statistically significant (P < 0.05). The average stent patency times in groups A and B were 3.55 ± 0.76 months and 8.76 ± 1.85 months, respectively (P < 0.05). The average survival times in groups A and B were 133.5 ± 27.8 days and 252.5 ± 114.5 days, respectively (P < 0.05). There was no statistically significant difference in the incidence of complications between the two groups (P > 0.05). CONCLUSION: Double-strand 125I seeds radiotherapy biliary drainage tubes can safely and effectively control tumors, prolong the patency of biliary stents, and prolong patient survival.

A preliminary study of radioulnar wrist compression in improving patient-reported outcomes of carpal tunnel syndrome.

Previous studies have shown radioulnar wrist compression augments carpal arch space. This study investigated the effects of radioulnar wrist compression on patient-reported outcomes associated with carpal tunnel syndrome. Subjects underwent thrice-daily (15 min each time 45 min daily) wrist compression over 4 weeks with an additional four weeks of follow-up without treatment. Primary outcomes included Boston Carpal Tunnel Questionnaire symptom and functional severity scales (SSS and FSS) and symptoms of numbness/tingling based on Visual Analog Scales. Our results showed that radioulnar wrist compression improved SSS by 0.55 points after 2 weeks (p < 0.001) and 0.51 points at 4 weeks (p < 0.006) compared to the baseline scale. At the four-week follow-up, SSS remined improved at 0.47 points (p < 0.05). Symptoms of numbness/tingling improved at two and 4 weeks, as well as the follow-up (p < 0.05). Hand motor impairment such as weakness had a lower frequency across carpal tunnel syndrome sufferers and does not significantly improve (p > 0.05). Radioulnar wrist compression might be an effective alternative treatment in improving sensory related symptoms in patients with mild to moderate carpal tunnel syndrome.

Reach-to-grasp kinematics and kinetics with and without visual feedback in early-stage Alzheimer's disease.

This study aimed to investigate the effects of early-stage Alzheimer's disease (AD) on the reach-to-grasp kinematics and kinetics with and without visual supervision of the grasping arm and hand. Seventeen patients who had been diagnosed with early-stage AD and 17 age- and gender-matched, cognitive normal (CN) adults participated in the experiment. A mirror operating system was designed to block the visual feedback of their grasping hand and forearms but to virtually show grasped targets. The target for reach-to-grasp kinematics was a reflective marker installed on a base; and the target for reach-to-grasp kinetics was a custom-made apparatus installed with two six-component force/torque transducers. Kinematics and kinetic parameters were used to quantify the reach-to-grasp performances. Results showed that the early-stage AD remarkably decreased the reaching speed, reduced the grasping accuracy and increased the transportation variability for reach-to-grasp kinematics. For kinetic analysis, early-stage AD extended the preload duration, disturbed the grip and lift forces coordination, and increased the feedforward proportion in the grasping force control. The AD-related changes in the reach-to-grasp kinematic and kinetic parameters depended on visual feedback and were associated with nervous system function according to correlation analyses with the neuropsychological testing. These results suggest that the abnormal kinematic and kinetic characteristics may correlate with the neuropsychological status of early-stage AD, and that the reach-to-grasp kinematic and kinetic maneuver could potentially be used as a novel tool for non-invasive screening or evaluation of early-stage AD.

Ulnar Extension Coupling in Functional Wrist Kinematics During Hand Activities of Daily Living.

PURPOSE: Wrist circumduction is increasingly used as a functional motion assessment for patients. Thus, increasing our understanding of its relation to the functional motion envelope is valuable. Previous studies have shown that the wrist is preferentially extended during hand activities of daily living (ADLs), with greater ulnar than radial deviation. The purpose of this study was to characterize the functional wrist motions of 22 modern ADLs in healthy subjects. We hypothesized that the subjects would perform ADLs predominantly in ulnar extension. METHODS: Ten right-handed, healthy subjects performed flexion-extension, radioulnar deviation, maximal circumduction, and 22 modern ADLs. Angular wrist positions were obtained by tracking retroreflective markers on the hand and forearm. Angular motion data were analyzed with a custom program for peak/trough angles in flexion extension and radioulnar deviation, ellipse area of circumduction data, and ellipse area of combined motion data. RESULTS: The required ranges of motion for ADLs were from 46.6° ± 16.5° of flexion (stirring task) to 63.8° ± 14.2° of extension (combing) in flexion-extension and from 15.6° ± 8.9° of radial deviation (opening a jar) to 32.5° ± 8.3° of ulnar deviation (picking up smartphone) in radioulnar deviation. Ellipse area of combined motion data of the 22 ADLs were, on average, 58.2% ± 14.3% of the ellipse area of maximal circumduction. A motion data quadrantal analysis revealed that 54.9% of all ADL wrist motion occurred in ulnar extension. Among the average wrist positions for 22 ADLs, 16 were located in the ulnar extension quadrant. CONCLUSIONS: This study revealed a functional wrist motion envelope that was less than 60% of wrist maximal motion capacity on average. Our results also showed that the majority of ADLs are performed in ulnar extension of the wrist. CLINICAL RELEVANCE: Baseline values for healthy subjects performing 22 wrist ADLs can inform future studies assessing dysfunction, postsurgical changes, and rehabilitation progress.

Metformin attenuates synergic effect of diabetes mellitus and Helicobacter pylori infection on gastric cancer cells proliferation by suppressing PTEN expression.

It has been reported that CagA of Helicobacter pylori reduced PTEN expression by enhancing its promoter methylation. Furthermore, diabetes mellitus (DM) may also promote the methylation status of PTEN, a tumour suppressor gene in gastric cancer (GC). It is intriguing to explore whether DM may strengthen the tumorigenic effect of H pylori (HP) by promoting the methylation of PTEN promoter and whether the administration of metformin may reduce the risk of GC by suppressing the methylation of PTEN promoter. In this study, we enrolled 107 GC patients and grouped them as HP(-)DM(-) group, HP(+)DM(-) group and HP(+)DM(+) group. Bisulphite sequencing PCR evaluated methylation of PTEN promoter. Quantitative real-time PCR, immunohistochemistry and Western blot, immunofluorescence, flow cytometry and MTT assay were performed accordingly. DNA methylation of PTEN promoter was synergistically enhanced in HP(+)DM(+) patients, and the expression of PTEN was suppressed in HP(+)DM(+) patients. Cell apoptosis was decreased in HP(+)DM(+) group. Metformin showed an apparent effect on restoring CagA-induced elevation of PTEN promoter methylation, thus attenuating the PTEN expression. The reduced PTEN level led to increased proliferation and inhibited apoptosis of HGC-27 cells. In this study, we collected GC tumour tissues from GC patients with or without DM/HP to compare their PTEN methylation and expression while testing the effect of metformin on the methylation of PTEN promoter. In summary, our study suggested that DM could strengthen the tumorigenic effect of HP by promoting the PTEN promoter methylation, while metformin reduces GC risk by suppressing PTEN promoter methylation.

Recent advances in continuous extraction of bioactive ingredients from food-processing wastes by pulsed electric fields.

The food processing produces a great amount of wastes that are rich in nutrients. Extraction is the first and most important step in recovery and purification of active ingredients from these wastes. The traditional extraction technologies are known to be laborious and time-consuming, require large volumes of organic solvent, have high temperature and energy costs, and obtain relatively low extraction efficiency. In recent 10 years, a novel, efficient and green extraction method, pulsed electric fields (PEFs) continuous extraction, which is emerging non-thermal food-processing technology, has shown great promise in extracting these food wastes. This work gives an overview of development in the use of PEF continuous extraction for obtaining bioactive ingredients from food-processing wastes. The technology is described in detail with respect to the mechanism, equipment, critical parameters. The protocols and applications of the technology in the extraction of food-processing wastes are comprehensively summarized. Finally, the degradation of bioactive ingredients, industrial applications, problem of novel food, consumer acceptance, and future trends of the technology are discussed. The PEF continuous extraction is considered as the ideal technology of high efficiency and low temperature for natural ingredients extraction. The technology possesses many remarkable potential applications in the food-processing industries compared to the conventional extraction methods.

Carpal Arch Changes in Response to Thenar Muscle Loading.

This study investigated the biomechanical effects of thenar muscles (abductor pollicis brevis (APB), superficial head of flexor pollicis brevis (sFPB), opponens pollicis (OPP)) on the transverse carpal ligament formed carpal arch under force application by individual or combined muscles (APB, sFPB, OPP, APB-sFPB, sFPB-OPP, APB-OPP, and APB-sFPB-OPP). In ten cadaveric hands, thenar muscles were loaded under 15% of their respective maximal force capacity, and ultrasound images of the cross section of the distal carpal tunnel were collected for morphometric analyses of the carpal arch. The carpal arch height and area were significantly dependent on the loading condition (p < 0.01), muscle combination (p < 0.05), and their interaction (p < 0.01). The changes to arch height and area were significantly dependent on the muscle combinations (p = 0.001 and p < 0.001, respectively). The arch height and area increased under the loading combinations of APB, OPP, APB-sFPB, APB-OPP, or APB-sFPB-OPP (p < 0.05), but not under the combinations of sFPB (p = 0.893) or sFPB-OPP (p = 0.338). The carpal arch change under the APB-sFPB-OPP or APB-OPP loading was greater than that under the loading of APB-sFPB (p < 0.001). This study demonstrated that thenar muscle forces exert biomechanical effects on the transverse carpal ligament to increase carpal arch height and area, and these increases were different for individual muscles and their combinations.

Location-dependent change of median nerve mobility in the carpal tunnel of patients with carpal tunnel syndrome.

INTRODUCTION: The purpose of this study was to investigate in vivo median nerve longitudinal mobility in different segments of the carpal tunnel associated with active finger motion in carpal tunnel syndrome (CTS) patients in a comparison with healthy controls. METHODS: Eleven healthy volunteers and 11 CTS patients participated in this study. Dynamic ultrasound images captured location-dependent longitudinal median nerve mobility within the carpal tunnel during finger flexion at the metacarpophalangeal joints using a speckle cross-correlation algorithm. RESULTS: Median nerve longitudinal mobility in the carpal tunnel was significantly smaller in CTS patients (0.0037 ± 0.0011 mm/degree) compared with controls (0.0082 ± 0.0026 mm/degree) (P < .05), especially in the proximal (0.0064 vs 0.0132 mm/degree on average) and middle (0.0033 vs 0.0074 mm/degree on average) carpal tunnel sections. DISCUSSION: Median nerve mobility can potentially serve as a biomechanical marker when diagnosing CTS, or when assessing the effectiveness of surgical and conservative treatments.

Ligament and Bone Arch Partition of the Carpal Tunnel by Three-Dimensional Ultrasonography.

The carpal tunnel is geometrically irregular due to the complex composition of many carpal bones intercalated by numerous intercarpal ligaments. The purpose of the study was to investigate the relative contributions of the ligament and bone arches to carpal tunnel space at the proximal, middle, and distal tunnel regions. A catheter ultrasound probe acquired fan-like images inside cadaveric carpal tunnels for three-dimensional reconstruction of the tunnel. The total tunnel volume was 5367.6 ± 940.1 mm3 with contributions of 12.0%, 6.9%, and 4.1% by proximal, middle, and distal ligament arches, respectively, and 27.0%, 25.3%, and 24.7% by proximal, middle, and distal bone arches, respectively. The bone arch occupied more tunnel space than the ligament arch at all regions (p < 0.05). The ligament arch was largest at the proximal region of the tunnel and significantly decreased toward the distal region (p < 0.05). However, the bone arch significantly decreased only from the proximal to middle region (p < 0.05) but not from the middle to distal region (p = 0.311). Consequently, it was observed that the ligament arch was the key contributor to the unequal carpal tunnel space across regions. Partitional and regional tunnel morphometric information may provide a better understanding of tunnel abnormality associated with various wrist pathological conditions. The developed framework of ultrasonography and data processing can be applied to other areas of interest in the musculoskeletal system.

Biometry of thenar muscle origins on the flexor retinaculum.

The transverse carpal ligament (TCL), the main part of the flexor retinaculum, serves as an anchor for the thenar muscles: abductor pollicis brevis (APB), superficial head of the flexor pollicis brevis (sFPB), and opponens pollicis (OPP). Biomechanically, the thenar muscles rely on their TCL anchoring to transmit muscle contractions distally for thumb force and motion production, and reciprocally, muscle contraction interacts with the TCL at the proximal end through the origins. However, scarce knowledge exists regarding the distribution pattern of the thenar muscle origins. The purpose of this study was to understand the anatomical interface between the thenar muscles and TCL by examining the origin distributions of the individual muscles. Ten cadaveric specimens were dissected for digitization of the muscle origins and TCL volar surface. Digitized data were used for mesh reconstruction and calculation of surface areas and centroids. The origin areas for APB, sFPB, and OPP were 105.8 ± 30.3, 64.6 ± 15.2, and 245.9 ± 70.7 mm2 , respectively. The surface area of the TCL was 386.2 ± 86.9 mm2 . The origin areas of APB and OPP on the TCL were comparable, 18.4 ± 4.8% and 17.3 ± 9.6% of the TCL area, respectively. The origin locations for APB, sFPB, and OPP were in proximal-radial quadrant of the TCL, on distal aponeurosis outside the TCL, and around the ridge of trapezium, respectively. The knowledge of the anatomical interface provides a foundation for the understanding of biomechanical interactions between the muscles and ligaments and pathomechanical implications.

Placement of a newly designed partially covered T- or Y-configured self-expanding metallic stent for hilar biliary obstruction: technical note.

PURPOSE: To investigate the technical success, efficacy, and safety of a newly designed partially covered bilateral self-expanding metallic stent (SEMS) in patients with malignant biliary obstruction. MATERIAL AND METHODS: From May 2016 to November 2017, ten patients with malignant hilar biliary stenosis (bismuth type II-IV) underwent stent placement with the newly designed partially covered T/Y-configured SEMS. Technical success, drainage catheter removal, jaundice remission, early and late complications, stent patency, and overall survival were analyzed. RESULTS: The stent was successfully deployed in all patients. The total bilirubin level significantly decreased one month after stent placement (P < 0.05). Drainage catheter removal rate was 90%. Two cases (20%) experienced early complications (bile duct hemorrhage and cholangitis) and two cases (20%) experienced late complications (hepatic abscess and cholangitis). During the follow-up (mean 276 days; range 57-503 days) stent occlusion occurred in three patients (30%), and two patents died of hepatic failure. The median stent patency and overall survival were 275 days (95% CI 223.8-326.3 days) and 428.9 days (95% CI 347.9-509.8 days), respectively. CONCLUSION: The newly designed partially covered T/Y-configured SEMS is technically feasible and clinically effective for biliary trifurcation obstruction.

RUNX2 Plays An Oncogenic Role in Esophageal Carcinoma by Activating the PI3K/AKT and ERK Signaling Pathways.

BACKGROUND/AIMS: Esophageal carcinoma is a frequently occurring cancer at upper gastrointestinal tract. We aimed to evaluate the roles and possible mechanism of Runt Related Transcription Factor 2 (RUNX2) in the development of esophageal cancer. METHODS: The expression of RUNX2 in esophageal carcinoma tissues and cells was investigated by qRT-PCR. Effects of RUNX2 on cell viability, apoptosis, migration and invasion were assessed using MTT assay, flow cytometry assay/western blot analysis, and Transwell assays, respectively. Afterwards, effects of RUNX2 on of the activation of the PI3K/AKT and ERK pathways were explored by Western blot analysis. In addition, a PI3K/AKT pathway inhibitor LY294002 and an ERK inhibitor U0126 were applied to further verify the regulatory relationship between RUNX2 and the PI3K/AKT and ERK signaling pathways. Besides, the RUNX2 function on tumor formation in vivo was investigated by tumor xenograft experiment. RESULTS: The result showed that RUNX2 was highly expressed in esophageal carcinoma tissues and cells. Knockdown of RUNX2 significantly inhibited TE-1 and EC-109 cell viability, repressed TE-1 cell migration and invasion, and increased TE-1 cell apoptosis. RUNX2 overexpression showed the opposite effects on HET-1A cells. Moreover, RUNX2-mediated TE-1 cell viability, migration and invasion were associated with the activation of the PI3K/AKT and ERK pathways. Besides, knockdown of RUNX2 markedly suppressed tumor formation in vivo. CONCLUSION: Our results indicate that RUNX2 may play an oncogenic role in esophageal carcinoma by activating the PI3K/ AKT and ERK pathways. RUNX2 may serve as a potent target for the treatment of esophageal carcinoma.

Flat detector cone beam CT-guided nephrostomy using virtual navigation in patients with iatrogenic ureteral injury.

PURPOSE: To evaluate the feasibility of flat detector cone beam computed tomography (CBCT)-guided nephrostomy using virtual navigation in patients with iatrogenic ureteral injury. MATERIALS AND METHODS: A retrospective review of percutaneous nephrostomy (PN) revealed the use of CBCT with 3D virtual navigation guidance in 42 procedures (40 patients) for patients with iatrogenic ureteral injury. All procedures were shown as second-line interventions after failed ultrasound-guided nephrostomy. Data on technical success rate, procedure time, puncture performance, radiation exposure, complications, and clinical success were collected. RESULTS: The technical success rate was 95.2% (40/42). The mean puncture performance score was 4.4 ± 1.0, and the procedure time was 25.2 ± 3.1 min, resulting in a mean effective exposure dose of 5.9 ± 2.3 mSv. There were no serious complications. During the mean follow-up periods of 11.4 months (range 6-19), clinical success rates following drainage were 72.5% (29/40), and ten cases (25%) had secondary surgical treatments. CONCLUSION: CBCT with 3D virtual navigation is a feasible technique for PN with reasonable exposure dose and can serve as a second-line intervention after failed ultrasound guidance.